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December 15, 1999

Social Issues: School and Daycare

Question from Maryland, USA:

I am a school psychologist involved with a situation in which the parent of a middle school aged young man is concerned about the appropriateness of following the school discipline policy with her diabetic son. The student also has symptoms of ADHD and is on special education monitoring status as Other Health Impaired. The behaviors of concern include making inappropriate sexual comments to other students, picking his nose and making comments relative to this to other students, and making disruptive noise in class. There is documentation of aggressive and noncompliant episodes as well. The student's mother states that these are manifestations of the student's low and/or high blood sugar levels, and as such should not result in disciplinary action. The current plan is for teachers to call the office for an escort to the nurses office for a blood sugar check whenever a behavioral incident occurs. If a high or low is present, the nurse provides treatment. The student is currently held to the school discipline policy which may include a verbal warning, detention, in-school suspension, or out of school suspension. The IEP team is trying to write an appropriate behavioral procedure for the child's Individual Education Plan, but needs guidance concerning how to balance the medical needs of this student, the need to teach the student personal responsibility for his behavior, and the rights of other students to an appropriate learning environment. The parent has been requested to have medical information forwarded by the child's physician, but only general statements such as "the student's diabetes may affect his behavior" have been received. Could you offer some guidelines?


In general, any inappropriate behavior by any child should be addressed via the discipline policy. When a person has diabetes, the only thing that needs to be added to the policy is a blood sugar check immediately following the inappropriate behavior. If the blood sugar check suggests that the student is experiencing a low blood sugar (60 or lower), then the low blood sugar must be treated immediately (juice, milk, regular pop, etc). If the sugar is low, then that individual’s brain is not getting enough sugar, and is not working effectively. Behavior, mood, and judgement can all be impaired. It is during such an event that it would not make sense to hold the child accountable for his behavior. It is vital, however, to then work with the family and the diabetes team to prevent such lows from occurring in school.

If this student’s blood sugars are over 60 and under about 200 or 250, then the behavior should be handled according to the discipline policy of the school. If his blood sugars are over 250, then he might not be feeling well and his high blood sugars need to be addressed (talk with his diabetes team to learn of their recommendations for handling high numbers in school). However, even if this student does not feel well, he is still in control of his behavior. His ability to think clearly and his judgement are not impaired. Therefore, if he misbehaves, he should still be subject to the school discipline policy.

In sum, unless this student has a low blood sugar, he should be held responsible for his behaviors.